关键词: 脊柱骨折, 椎体后凸成形术, 麻醉,静脉, 麻醉, 局部

Abstract: Objective To explore the effectiveness and safety of dexmedetomidine combined with local anesthesia for percutaneous kyphoplasty(PKP) in the treatment of elderly patients(age ≥80 years) with thoracolumbar fractures. 
Methods A total of 36 elderly patients with osteoporotic vertebral compression fractures who were selected for PKP were divided into intravenous anesthesia combined with local anesthesia group(observation group, n=19) and local anesthesia group(control group, n=17) according to presence or absence of combined intravenous anesthesia. In the observation group, intravenous pumping of dexmedetomidine was used during the operation, followed by intravenous administration at a loading dose of 0.5 μg/kg 10 min before anesthesia, and 0.4 μg·kg-1·h-1 maintenance dose until the end of the operation. Both groups were anesthetized with 1.0% lidocaine for local infiltration,with a total volume of 40 mL.The duration of operation and satisfaction score of perioperative pain management in both groups were recorded. Mean arterial pressure(MAP), heart rate(HR), blood oxygen saturation(SpO2) and pain visual analogue scale(VAS) score before operation(T0), during local anesthesia(T1), during puncture into the vertebral body(T2), during balloon expansion(T3), during injection of bone cement(T4), and at the end of surgery(T5)of the two groups were recorded. The occurrence of anesthesia-related adverse reactions and complications was recorded. 
Results There was no statistically significant difference in duration of operation between the two groups(P＞0.05). Satisfaction score of perioperative pain management was higher in observation group than in the control group, and the difference was statistically significant(P＜0.05). The MAP, HR, and VAS scores of the two groups fluctuated. The MAP, HR, and VAS scores of the observation group were lower than those of the control group. The differences in the interaction between groups, time points, and time points between groups were statistically significant(P＜0.05); the time points in SpO2 between two groups were statistically significant(P＜0.05), and there was no statistically significant difference in SpO2 in the interaction between groups, and time points between groups(P＞0.05). During the perioperative period, there were no anesthesia-related complications such as bradycardia, hypoxemia, and blood pressure fluctuations in the two groups. There was no significant difference in the incidence of bone cement leakage between the two groups(P＞0.05). 
Conclusion Low-dose dexmedetomidine combined with local anesthesia provides a safe and effective anesthesia program for elderly patients with PKP, which can effectively reduce the hemodynamic response during perioperative period. 

Key words: spinal fractures, kyphoplasty, anesthesia, intravenous, anesthesia, local